Long-term risks, benefits associated with C-section revealed

Women who give birth by cesarean section, or C-section, may have a decreased risk of urinary incontinence and pelvic prolapse, but an increased risk of miscarriage or stillbirth in future pregnancies when compared to those with vaginal deliveries, new research suggested Tuesday.

The findings, published in the U.S. journal PLOS Medicine, were based on a systemic literature review of 80 studies involving nearly 30 million participants that assessed long-term outcomes following C-section delivery compared with vaginal delivery.

"Cesarean delivery rates are rising worldwide, and in particular, rates of cesarean delivery without medical indication are increasing," said the research led by Sarah Stock of the University of Edinburgh in Britain.

"This review aims to synthesize the available evidence on the long-term associations with cesarean delivery."

Compared with vaginal deliveries, C-section deliveries were found to be associated with a 44 percent decreased risk of urinary incontinence and a 71 percent decreased risk of pelvic prolapse.

Children delivered by C-sections had an increased risk of asthma for up to 12 years and obesity up to five years of age.

Pregnancy after C-section delivery was associated with an increased risk of miscarriage, stillbirth, placenta previa, placenta accreta, and placental abruption.

"This information should help inform discussions about mode of delivery, and may facilitate appropriate personalized delivery planning and shared decision making," the study said.

Given that the findings were predominantly based on observational data, causation cannot be inferred and the findings should be interpreted with caution, it added.

Professor Susan Wray of the University of Liverpool, who was not involved in the study, said the conclusions from the study are "timely and important."

"This information will be useful to both women and those involved in their care, especially when contemplating a C-section for non-medical reasons," Wray said.

"Knowing there are increased risks associated with a C-section of miscarriage and still birth for future pregnancies, even though the increased risks are very small, may weigh more heavily for some women than the associated benefits of decreased risk of prolapse and urinary incontinence, and vice versa."